What Are the Different Types of Groin Injuries?

Inguinal ligament: The part of the external oblique tendon that is thickened and reversed from the anterior superior iliac spine to the pubic tubercle. After the spermatic cords of the fibers from the lateral foot are sent inward, they migrate to the anterior layer of the rectus abdominis sheath, called the inverted ligament; the fibers from the medial end of the lateral foot that bends backward and outward form the lacunar ligament (pithole ligament).

Chinese name: Inguinal ligament
Foreign name: inguinal ligament

Nature: Anatomical nouns
Related disciplines: Medical anatomy

Overview of Inguinal Ligaments

Inguinal sulcus at the junction of the thigh and the abdomen. The crotch is triangular. The upper boundary extends from the anterior superior iliac spine to the outer edge of the rectus abdominis. , Is a marker to identify inguinal hernia and femoral hernia. The structure of each layer in this area is weak, and it can withstand the pressure in the abdomen. The spermatic cord and the round ligament of the uterus all pass through it.

Inguinal ligament anatomy

The lower edge of the external oblique tendon is curled and thickened, located between the anterior superior iliac spine and the pubic tubercle. The fibers above its inner end split into a triangular hole, the subcutaneous ring. The upper and inner fibers stop at the front of the pubic symphysis, called the medial foot; the lower and outer fibers stop at the pubic tubercle, which is the lateral foot. Between the two feet, the fibers between the feet are connected by ligaments. After the inferior fibers from the lateral feet pass through the spermatic cord, they are moved to the anterior layer of the rectus abdominis sheath, called the inverted ligament; the fibers at the inner end of the lateral feet that bend backward and outward form the lacunar ligaments (pits ligaments).

The groin is a triangular area on either side of the lower abdomen. The medial boundary is the outer edge of the rectus abdominis, the upper boundary is the horizontal line from the superior superior iliac spine to the outer edge of the rectus abdominis, and the lower boundary is the inguinal ligament. This area is relatively weak. 3 times higher when lying, because of the anatomy and physiological characteristics, so hernias occur in this area.

Inguinal ligament inguinal hernia repair

Inguinal hernia repair is the main method for treating inguinal hernia. The disease is mainly caused by the large abdominal ring and the inguinal canal being expanded, which causes the contents of the abdominal cavity to slide down the inguinal canal into the scrotum. Therefore, the operation is to remove the hernia sac and strengthen the anterior or posterior wall of the inguinal canal to narrow the gap and prevent the contents of the abdominal cavity from descending. It is forbidden to increase abdominal pressure after surgery to prevent constipation and the effect is good.

Inguinal ligament and groin-related diseases

Inguinal hernia:

Abdominal organs that protrude through the abdominal wall defect in the groin, called inguinal hernias, are the most common extra-abdominal hernia, accounting for 90% of all extra-abdominal hernias. According to the relationship between the hernia ring and the inferior abdominal wall artery, inguinal hernia is divided into two types: indirect hernia and straight inguinal hernia. The hernia sac protrudes through the deep inguinal canal outside the inferior abdominal wall, diagonally inward, downward, and forward through the inguinal canal, then through the superficial inguinal canal, and can enter the scrotum, called an inguinal hernia, which accounts for the inguinal hernia. 95%. The majority of male patients, the male to female incidence ratio is 15: 1, the right side is more common than the left side.

Complaint:

The patient complained that a lump appeared in the groin area or in the scrotum, which appeared more than when standing, walking, laboring, and severe coughing. If it was an infant, it could appear when crying. When lying down or pressing by hand, the lump could be collected by itself and disappeared. Only occasionally with local tenderness and involved pain.

Clinical features of inguinal ligament

Main performance

(1) A lump appears in the groin area or in the scrotum.

(2) Partial falling sensation, pain and involved pain.

2. Secondary manifestations may be accompanied by digestive symptoms such as indigestion, nausea, vomiting, and constipation.

3. Misdiagnosis and analysis of straight hernia, hydrocele, testicular insufficiency, inguinal lymphadenopathy, popliteal abscess and other diseases can be manifested as inguinal mass, so it is easy to be misdiagnosed as inguinal hernia.

The clinical physical examination must be careful and careful. The size, texture, boundary, and activity of the tumor should be carefully understood, and the situation of the inner and outer rings should be paid special attention to. An important point for identifying an inguinal hernia is that the oblique hernia protrudes through the inguinal canal and can often enter the scrotum. After receiving the hernia mass, the inner ring is pressed and the hernia mass no longer protrudes. The neck of the hernia sac is outside the inferior abdominal artery and the hernia mass is generally impermeable. Light. Straight and oblique hernias, hydrocele, and oblique hernias are more confusing and should be given special attention. The position of the popliteal abscess is mostly to the outside of the right groin, the edges are unclear, and the texture is soft and fluctuating. Tuberculous lesions are sometimes seen in the lumbar spine or sacroiliac joint.

Inguinal ligament assisted examination

Clinical diagnosis is mainly based on surgical physical examination, but auxiliary examination is still of great significance in identifying the disease.

1. The first examination of B-ultrasound can determine the nature and size of hernia contents and the relationship with the inferior abdominal wall arteries, which is an important means of differential diagnosis.

Secondary inspection

(1) CT examination: Through tomography, it can be directly observed that the contents of the hernia enter the deep inguinal canal.

(2) X-ray examination: In the presence of hernia incarceration or strangulation, plain film or gastrointestinal angiography with diaglumine is of certain value for diagnosis.

3. Inspection precautions

(1) Recurrent hernias are often visible in the upright position, but the supine position disappears. In the B-ultrasound, an upright position examination is feasible.

(2) In the presence of hernia incarceration or strangulation, try not to use barium for gastrointestinal angiography. If colon is incarcerated, colonoscopy and other examinations should be performed with caution.

Essentials for Inguinal Ligament Treatment

(A) treatment principles

1. Surgical treatment of inguinal hernia is mainly surgical treatment. If chronic cough, difficulty urinating, constipation, ascites, pregnancy and other increased intra-abdominal pressure exist, it should be treated before surgery.

2. The infant's abdominal muscles can be gradually strengthened as the body grows conservatively, and the hernia may disappear on its own, so infants under 1 year of age may not be operated temporarily. Those who are old or frail or accompanied by other more serious diseases and whose intestinal loop has not been strangulated and necrotic are estimated. Generally, the incarceration time is within 3 to 4 hours. In addition to the above two points, surgery is the most effective way to treat inguinal hernia.

(Two) specific treatment methods

The basic principle of inguinal hernia surgery is to close the hernia, the inner ring mouth, and strengthen or repair the wall of the inguinal canal. There are many surgical methods, but they can be classified into two types: simple hernia sac high ligation and hernia repair.

1. The simple hernia sac high ligation operation reveals the oblique hernia sac neck at the inner ring. A thick silk thread is used at the root of the sac neck for high ligation or through suture, and then the hernia sac is removed. This operation does not repair the weak areas of the groin area, and is only suitable for infants and young children. The weak areas can gradually strengthen in the later development of abdominal muscles. Adults who undergo this operation are prone to recurrence. Intestinal necrosis occurred with severe cases of local infection.

2. After hernia repair, the hernia sac neck is severed and ligated, and the weak or inferior inguinal canal wall can be strengthened or repaired. It is called hernia repair, and the methods include traditional hernia repair, tension-free hernia repair and laparoscopy. Hernia repair.

(1) Traditional hernia repair:

Strengthening the anterior wall of the inguinal canal:

Ferguson method: After the hernia sac neck is cut for high ligation, the spermatic cord is not released, and the lower edge of the internal oblique muscle and the joint tendon are sutured to the inguinal ligament in front of the spermatic cord to eliminate the weak area between the two. It is suitable for small oblique hernias in adults and children with no obvious defects in the abdominal transverse aponeurotic arch and a sound inguinal posterior wall.

Strengthen the posterior wall of the groin:

Bassini method: After the neck of the hernia sac is cut and ligated high, the spermatic cord is lifted freely, and the lower edge of the internal oblique muscle and the joint tendon are sutured to the inguinal ligament behind the spermatic cord to strengthen the posterior wall of the inguinal canal. After the operation, the spermatic cord was displaced between the internal oblique and external oblique tendons. This method is the most widely used and is suitable for adults with inguinal oblique hernias and generally weak abdominal walls.

Halsted method: The difference from the Bassini method is that the spermatic cord is placed under the skin. On the deep side of the spermatic cord, the internal oblique muscle, combined tendon and inguinal ligament were sutured, and then the external oblique tendon suture was sutured. This method is suitable for oblique hernias with severely weak abdominal wall muscles, but due to high spermatic cord displacement, it may affect its development and is not suitable for children and young patients.

McVay method: The difference between this method and the Bassini method is that the lower edge of the internal oblique muscle and the combined tendon are sewn on the pubic comb ligament to achieve the purpose of strengthening the posterior wall of the inguinal canal. This method also moves the spermatic cord between the abdominal oblique muscle and the external oblique tendon, which is suitable for adults with large oblique hernias, elderly and recurrent oblique hernias with severe abdominal wall muscle weakness.

Shouldice method: Based on the occurrence of inguinal hernia mainly due to weak or defective abdominal fascia, the main point of this operation is to emphasize strengthening the abdominal fascia. After the hernia sac is ligated high, the transverse transverse fascia is cut open from the pubic tubercle up to the inner ring, and then the two leaves that are cut are overlapped and sutured, and the outer lower lobe is sutured deep in the inner upper lobe and the inner oblique muscle. Face, and then sew the edge of the medial superior leaf to the inguinal ligament. Then the lower edge of the internal oblique muscle and the joint tendon were sutured to the deep side of the inguinal ligament according to the Bassini method.

(2) Tension-free hernia repair: After the hernia sac is separated, the hernia sac is inverted and sent into the abdominal cavity. There is no need to ligate the hernia sac high in the traditional way. Then use a synthetic fiber mesh to make a cylindrical petal-shaped filling, fill it at the inner ring of the hernia to fill the defect of the hernia ring, and then suture a synthetic fiber mesh to the back wall of the inguinal canal to replace the traditional tension Suture. Tension-free hernia repair can shorten time, reduce postoperative complications, and reduce hernia recurrence.

(3) Laparoscopic hernia repair:

Trans-abdominal preperitoneal method: Incision of the free groin area peritoneum in the abdominal cavity, after processing the hernia sac, implant a mesh in the preperitoneal space, fix it on the transverse abdominis tendon arch, zygomatic bundle, and pubic comb ligament, and then close the peritoneum The incision strengthens the entire weak area of the groin, including the thigh, the inner ring, and the triangle of the straight hernia.

Complete extraperitoneal method: The basic surgical method is the same as the transperitoneal preperitoneal method, but instead of entering the abdominal cavity, a balloon stent is used to create a visible and operable space in the preperitoneal space to complete the repair. There is no disadvantage of interperitoneal preperitoneal interference with the abdominal cavity, but the technical equipment is high and expensive.

Intra-abdominal mesh placement method: The site where the mesh is implanted is consistent with the above two methods, the difference is that the latter is directly fixed to the peritoneum.

(Three) precautions for treatment:

1. Misoperation or unclear local anatomy can cause various tissue injuries and complications. For example, the inferior iliac nerve and the iliac inguinal nerve are damaged when the external oblique tendon is cut or sutured. The internal spermatic cord is injured when the hernia sac is separated. The suture of the combined tendon and the inguinal ligament can damage the femoral artery and vein under the ligament. When the hernia sac is punctured with a high position, the hernia tissue in the abdominal cavity is damaged, which requires the operator to have a good anatomical foundation, and the operation is gentle.

2. Hernia repair should not be too high tension. When necessary, patch repair must be applied to prevent postoperative complications and hernia recurrence. Strict aseptic surgery should be paid attention to during surgery to avoid failure of repair due to infection. Strict hemostasis and subcutaneous hematoma and scrotum should be avoided. hematoma.

3. For incarcerated hernias, the vitality of the contents of the hernia should be correctly judged, and then the treatment method should be determined according to the condition. Not only the vitality of the intestinal loop in the hernia sac, but also the middle bowel loop in the abdominal cavity should be checked for necrosis, and the intestinal loop should slide in. When abdominal cavity, should be pulled out of the abdominal observation. Patients undergoing intestinal resection and anastomosis are generally not suitable for hernia repair after ligation of the hernia sac at a high position due to contamination of the surgical area, so as to avoid repair failure due to infection.